Given the South Western Veteran Administration Medical Center’s (SWVAMC) difficulty managing Veteran-centered palliative pain, does simulated palliative care education and standardized preparedness for nursing staff when compared to current standards alone, impact the quality of palliative pain management delivered to Veterans as determined by SAIL MDS short-stay pain management data with an initial baseline non-compliance rate of 30.5%?
Methods:
The intervention was comprised of eleven separate sessions of uniform content, where each nurse was highly encouraged by hospital based education and senior leadership to attend one. Each session was a 2.5 hour hands-on palliative pain management simulation involving RNs/LPNs working on the SWVAMC Community Living Center (CLC) based on theoretical concepts endorsed by the National Hospice and Palliative Care Organization (NHPCO) and Hospice and Palliative Nurses Association (HPNA). Through advanced education of palliative RNs / LPNs, the primary goal was to improve short-stay palliative pain management for Veterans at the SWVAMC when compared with the results prior to implementation of the hands on pain management education simulation. All participating nurses were also invited to participate in a focus group follow up four weeks after the conclusion of the last simulated educational session, to promote continuous quality improvement over time.
There was not any subject or participant recruitment as the simulation was given to a captive audience. The project was approved by Jacksonville University and SWVAMC Institutional Review Boards. Self-determination, full disclosure, and voluntary consent by all participants was obtained.
Results:
Sixteen out of twenty participants showed improvement on the post-test versus the pre-test (80% success rate). A paired sample T-Test (p=.001, T= 6.05) showed that learning did take place.
While combined FY18Q1/Q2 data showed a 30.5% failure in the ability for nursing to manage moderate to severe palliative pain for short-stay patients, FY18Q3 data showed a 41.4% failure rate (p=0.0354, Z=-2.12) indicating no improvement but decline in palliative pain management.
Conclusion:
Hands-on palliative pain management simulation has proven an effective tool to enhance nursing knowledge at the SWVAMC. Even though quality care results for Veterans were suboptimal, the end result is a starting point for a sustainable quality improvement plan.